Provider Demographics
NPI:1346325925
Name:WILES, LORI P (LIMHP, CPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:P
Last Name:WILES
Suffix:
Gender:F
Credentials:LIMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4297
Mailing Address - Country:US
Mailing Address - Phone:402-699-3468
Mailing Address - Fax:
Practice Address - Street 1:7551 MAIN ST STE 259
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127-5903
Practice Address - Country:US
Practice Address - Phone:402-699-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health